Gluten intolerance is pretty common with many people having been diagnosed with coeliac disease or non-coeliac gluten sensitivity. According to Coeliac NZ, 10% of the population are gluten intolerant and 80% of those with an ‘intolerance’ actually have undiagnosed coeliac disease. (1)  

There are also many people who may feel that they are intolerant to gluten…however it may not be gluten that is the problem, it may in fact be wheat OR fructans.

Symptoms

The problem is that the symptoms of coeliac disease, wheat allergy, gluten intolerance, wheat intolerance or a fructan intolerance can be similar and include abdominal pain, bloating, flatulence, trapped wind, diarrhoea, constipation, skin rashes and itching, acne, joint pain, nasal and sinus congestion, brain fog and problems thinking, headaches etc.

Many people may cut gluten from their diet because they believe they are sensitive to it because they experience symptoms after eating wheat based products. This makes it hard to know whether it is gluten or actually wheat that is causing the symptoms or even the new kid on the block, fructans. 

Assessment

If you have symptoms after eating bread type products, cereals, pasta etc  the first thing to do is to rule out coeliac’s disease which is an auto-immune condition not an allergy or intolerance. This is a blood test.   If this is negative then it’s worth getting an allergy test (skin or blood), if that’s negative then the next step is to do an elimination and challenge diet to determine if it’s gluten, wheat or fructans that you are sensitive to.     

 

So what’s the difference?  

Gluten

Gluten is an umbrella term for a specific group of storage proteins  known as prolamins (rich in an amino acid called proline) that are naturally found in certain grains, such as wheat, barley, and rye. Proteins called glutenins and gliadins are found in wheat, secalins are found in rye, hordeins found in barley and avenin found in oats. Gluten free alternatives corn and sorghum wheat also contain prolamins, zein and kafirin. (2)

The bugger is that some people react to all of these prolamins, some react to everything except avenin, zein and kafirin and some only react to gliadin and glutenin. 

Gluten is used a lot in the processing of food because of its glue-like effect, it gives bread its chewy, airy texture and also gets added to many products due to its ability to retain moisture and improve texture. It’s commonly used  as a preservative, thickener and stabiliser. 

There is a HUGE amount of information about gluten-free eating so I’m not going to focus on that here. If you want to know more about being gluten free then I highly recommend going to the following places: 

1. https://coeliac.org.nz/
2. https://glutenfreeshop.co.nz/
3. https://wickedwellbeing.com/

 

Wheat

Wheat is a grain and is found in LOTS of foods and also non-food products.  Being ‘wheat free’ doesn’t necessarily mean you have to be gluten free, as you can still consume barley, rye and oat products. 

• You will effectively have to be an avid label reader (in the same way that those who follow gluten free diets have to be): 
• Be cautious with processed foods such as bread and bread type products including indian flatbreads which traditionally are made from chickpea flour as many commercial flat breads are made from wheat, breakfast cereals, biscuits, crackers, cakes, pizza, pastries, soups, sauces and gravies, soy sauce, spices, chippies, processed meats, battered and breaded products and many ready made meals. 
• Avoid the following: bulgar wheat, durum wheat, couscous, einkorn, emmer, freekeh, spelt, hydrolysed wheat protein, kamut, malt (includes many beers), modified wheat starch, semolina, triticale, wheat bran, wheat germ and anything with ‘whole wheat’ in the title and seitan (a vegan meat-like product).  
• Wheat free alternatives you can have: wheat free breads, breadcrumbs, cakes, cereals, rye crackers, rye bread, oatcakes, corn cakes, rice cakes and crackers, wheat free pasta…
• Wheat free Grains: amaranth, barley, buckwheat, corn, maize/polenta, millet, oats, quinoa, rice, rye, sorghum.
• Wheat free Flours: such as buckwheat, chickpea (busan), coconut, almond, lentil, millet, oatbran, pea flour, potato, rice, teff, tapioca (3).

 

Tips (from British Dietetic Association) (3)

• Use crushed cornflakes, buckwheat, nuts and seeds esp. macadamia and almonds instead of breadcrumbs. 
• Ask in restaurants if they use wheat free sauces or wheat free soy
• Use wheat free gravy powders or use cornstarch instead as a thickener
• Try wheat free pastas – corn, quinoa, rice, buckwheat, legumes (I really like Ceres Quinoa pastas). 
• When making home- made sauces mix the ‘flour’ with a little cold water to make a paste add add warmed ‘milk’, water or stock slowly, stirring until thickened
• Check beers and lagers – most are made from barley but many European beers are made from only wheat or a wheat and barley mix. Always check the label first.
• If baking, check that you are using wheat free baking powder and you can xanthan gum to improve texture as a replacement for ‘gluten’. 

If you are wheat free then you will be largely eating gluten free foods BUT you can have barley, rye and oats. 

 

Fructans

To add to the confusion, some people have an intolerant to fructans. (4)

Fructans are a type of carbohydrate (one of the FODMAPs fermentable carbohydrates).  In fact, they are the O in FODMAPs. Oligosaccharides are made up of fructans and another form of carbohydrate called galacto-oligosaccharides.  Fructans are a chain of fructose and glucose (simple sugars).  We don’t have the enzymes that break these chains up into simple sugars. In most people they just pass through us, getting fermented along the way by our gut bacteria. That’s a good thing because the end results of this fermentation are short chain fatty acids that are hugely beneficial to our gut and general health. For some people, the fermentation causes a lot of gas that can be really uncomfortable. Fructans also draw water into the intestines which cause more bloating and diarrhoea in some people. (5)

A study in the journal Gastroenterology reported that fructans caused more digestive symptoms than gluten did in a group of people who thought they were gluten-sensitive.  In fact several studies have been undertaken recently that suggest that fructans are a bigger problem than gluten. In another study, 70% of people experiencing IBS improved their symptoms by reducing FODMAP foods rather than a gluten free diet  (which is why FODMAP diets are becoming more popular).  (6)

Fructans are found in wheat based products (as above) plus onions, shallots, spring onions, garlic, barley, Brussel sprouts, cabbage, broccoli, pistachio, artichokes, inulin and chicory root. Some people may react to barley but oats are usually OK. You may also be able to eat sourdough bread as the fermentation process means that fructans are much lower. 

 

So why shouldn’t we all just stop eating gluten, wheat or fructans and just be done with it. 

The short answer is because naturally containing gluten rich foods are beneficial containing many minerals, vitamins, fibre and are prebiotic rich so removing them, in the long run can actually ‘starve our good bacteria’ causing more digestive problems in the long term. In saying that there are also plenty of healthy alternatives. 

If you think you have a problem with gluten, wheat or fructans then please get tested first (coeliac and wheat allergy) and then if you are interested in the FODMAP diet and would like to find out more about whether you have a gluten, wheat or fructans intolerance then please let me know I would love to help. 

 

References

1. https://coeliac.org.nz/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866307/
3. https://www.bda.uk.com/resource/wheat-free-diet.html#:~:text=Wheat%2Dfree%20alternatives&text=Grains%3A%20amaranth%2C%20barley%2C%20buckwheat,rice%2C%20soya%2C%20teff%2C%20tapioca
4. https://www.gastrojournal.org/article/S0016-5085(17)36302-3/pdf
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934501/
6. https://www.gastrojournal.org/article/S0016-5085(13)01407-8/fulltext

 

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